The Autism Society Philippines (ASP) is a national, non-profit organization dedicated to the well-being of persons with autism spectrum disorder. The ASP has been in the forefront of providing services and training to families living with autism.

13 September 2010

MANILA, Philippines – When my son with autism had his first tooth extraction before age seven, it felt like winning the lotto! I heard of families who would spend thousands on general anesthesia for a simple tooth extraction but we only paid the dentist’s regular fee of P250. While other children with autism are traumatized during the process, some even have to be restrained with blankets or jackets, my son eagerly followed the dentist’s instruction to get his reward – a bottle of Coke.

Behind this huge success, we have our son’s special education teachers and his very patient dentist, Dr Cristina Chia, to thank. In fact, my son had been prepared for this through over a year of desensitization visits to the dentist’s clinic.

This week, Angel Talker Tiffany Tan interviewed two moms of children with autism. Chryril Carino is mom to Bennie, an adolescent with classic autism and is non-verbal. Barbara Lu is mom to Bryan, an adolescent with high-functioning autism. We gathered both their experiences from childhood to teen life on their personal habits, routines and challenges in dental care.

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FIRST VISITS

Mom Chyril: When Bennie was about three years old, we were concerned about his dental needs. A relative dentist suggested we inquire with Philippine Dental Society for a pediatric dentist who handles patients with special needs.

Bennie’s first visit wasn’t difficult. After the dentist established rapport with Bennie, he was given a patient’s drape to prevent him from moving around too much, and also to calm him. The only body part moving would be his head. Bennie was very obedient and compliant throughout the procedure.

PWA Bennie Cariño during one of his dental visits

Mom Barbara: Having previously handled children with special needs, Bryan’s dentist allowed him to move around, read magazines, and relax on the couch. He also Bryan to put different dental instruments into his own mouth. Bryan would sit on my lap so both of us would be reclining on the dental chair. Eventually, he learned to sit on the dental chair by himself because the dental visits were pleasant experiences.

ORAL HYGIENCE PRACTICE AT HOME

Mom Barbara: As a young boy, Bryan didn’t like brushing his teeth. I would use my finger to touch his teeth and gums gently. Later, he was asked to use his own finger to touch his molars and learn to be familiar with brushing motion on his teeth.

It took more than a year of training to teach him to use a toothbrush. However, even if his brushing were not perfect or properly done, but at least, he was using a toothbrush and has overcome one of his aversions or sensitivity to touch. After he got used to brushing his teeth, the next step was to schedule his first dental visit.

Mom Chyril: Under the Applied Behavior Analysis Program, Bennie’s schedule is structured and he is trained to do routines and tasks on his own. After every meal, he washes the dishes, packs them away and goes to brush his teeth.

PREPARING FOR A DENTAL VISIT

Mom Barbara: When Bryan was younger, we practiced the “pretend approach” by creating a scenario as we were in a dental office. I used the rocking chair as mock dental chair.

Mom Chyril: Since my son is non-verbal, to help communicate with him, we use pictures. Say we have a scheduled visit tomorrow, I will show Bennie a picture of his dentist, or a picture of him in the dental chair. This helps him understand what to expect.

There is no fear or haggling. You can also use cue cards (AAC) to aid with communication. Before we leave for the dentist on the actual day, I show him the photo again. Sometimes our dentist gives toys, drawing books or balloons as rewards for Bennie’s good behavior.

TOOTH EXTRACTION

Mom Barbara: Some of Bryan’s permanent teeth were oversized and overlapping. X-ray showed he had some excess teeth that caused his front teeth to be overlapped. His excess teeth were then extracted.

During the procedure, Bryan brought along his favorite book on Philippine Historical Markers to distract himself from the dental procedure. In one incident, after an extraction, he bit his lips until it bled because he felt that his lips were getting “bigger” (side effect of the local anesthesia).

BRACES

Mom Barbara: Bryan is wearing braces to correct a congenital defect on the canine teeth and teeth alignment. It was not easy to convince him to have his teeth fixed.

Initially, Bryan continued to show resistance by either crying at the mere mention of braces. He confided to his teacher his fear of pain. One summer, I brought up the subject of having a dental assessment. I took a candid photo showing Bryan’s unsightly teeth. With some encouragement, Bryan personally decided to his teeth fixed, so he would look more “gwapo”.

"Braces help me to look more gwapo," said PWA Bryan Lu

Fortunately, we met an understanding and considerate dentist who accommodated Bryan’s special needs such as singing loudly in the clinic or interrupting ongoing dental procedure just to ask questions or to read magazine.

Bryan had his braces at 11 yrs old. His threshold for pain is very high as compared to his brother who would not touch his dinner after every visit. (Both their braces are tightened every three weeks.)

After six years, a detachable expander was fitted in addition to the brace. Bryan lost three sets already! He would usually remove the expander before eating and wrap it in tissue. He would then forget to wear it after the meal or bring it home with him. The dentist gave up on the expander solution and resorted to a different treatment approach in combination with the brace.

CANDIES?

Mom Chyril: Bennie is allowed to eat sweets like candies and chocolates. We just make sure he brushes his teeth after every meal. Our dental visits are done every six months, without fail. And we never missed an appointment since that first visit. (Bennie is now 18). Before we leave the dental office, we make sure to set the next appointment and faithfully stick to the schedule.

The most important thing to remember is flossing – all front teeth including molars. Brush teeth first without the toothpaste using water and toothbrush only, then followed by brushing with toothpaste. Our dentist gave us brochures on proper dental care.

ADVICE FOR PARENTS

1. Look for “friendly” dentist who will allow the child to explore his/her dental tools.2. Don’t visit the dentist when your child is already experiencing pain, like a toothache. This will add to the anxiety of the first dental visit.3. Bring a favorite toy or book when he visits the dentist. This will give him a sense of familiarity, comfort and security.4. Familiarize the child by going on exposure trips to the dental clinic. This way it will be less stressful for both of you. It would be like a dental orientation for your child.

ADVICE FOR DENTISTS

1. If you are a dentist, tender care and abundant patience are a must.2. Friendly ambiance will somehow calm the patient.3. Gathering information prior to treatment will help you handle the child appropriately.4. But if you think you don’t have the needed patience, do not try to “test the water”.

Acknowledgments: Our special thanks to all the “angel dentists” especially to Dr. Fred Valera and Dr. Cristina Pangilinan, who both willingly and untiringly help children with special needs.

ASP’s monthly Family Support Group meeting on Sept. 18 will be facilitated by Belina Regalado, mother of international marimba prodigy with autism Tumtum Mendoza.Click here for more information

ASP's monthly Seminar-Workshop on Home Management Program will be on Sept. 25.Speakers: Ms. Rosalyn Marie Sorongon, Special Educator and Ms. Apple Malapad, mom to adolescent with autism. Click here for more details

hi! this is a very timely post for me. thanks for posting. one of my son's permanent front teeth is about to come out and the deciduous front tooth is wobbling already. we are very lucky to have a dentist (who happens to be my son's SPED teacher too) and so we are doing quite well. we need to do more frequent visits to the dentist though so that my son will be more comfortable in the dentist chair because that is our challenge now. Thanks again so much for the post.